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Too many cooks.

Where is MIL's PCP in all this? There needs to be one person co-ordinating her medical care, including regular reviews of her full px.

Sounds like MIL is fed to the back teeth of being, as she feels it, "got at."

That goes back to there being one person taking responsibility for negotiating with her and winning her agreement to a care plan. DH and SIL need to decide between them who gets that job: one of them, or MIL's PCP for choice.

You haven't got much time to get the hymn sheet together if the meeting's at ten - what time is it with you now?
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Countrymouse: It was about like this. MIL to be discharged, SIL arriving at airport at 6. What time is MIL to be released? Didn't know at that point, but it had been said release imminent. So I went to hospital to facilitate said transportation for discharge.

Now, I had said to SIL that I disagree that she should go home ..

She should be going to Rehab .. and should we be working that angle behind the scenes ..

But of course, the detour on that road was the whole piece about "Observation Outpatient" form that was given to her. Of course, with that in hand .. we can see .. that directing this thing to a Rehab stint .. will obviously mean a longer stay in the hospital and we'd need to get to work on behind the scenes communication with hospital staff if that's the direction we're going to take.

But the stumbling block to even beginning to go down that road was this piece of paper where it's evident .. ???..... they have .. at least for some portion of her stay .. had her as "outpatient/observation" that disqualifies her to go directly to Rehab .. and not only that, even if they DID classify her as "INPATIENT" she hasn't been for the 3 day requirement .. and so working to get add'l days .. so that qualification is met ... and then the next hurdle, getting her son and DIL dug in firmly . .. that she isn't safe to bring home (which is near impossible, if it's even possible).

So yes, I could've told SIL on the phone . as we worked to figure out who is going to get her (SIL not to arrive until 6 .. and the airport a good 30 mins from me, in one direction and then .. also consideration for discharge from the hospital and at what time, and the hospital .. a good 30 minutes from me in a complete other direction). I could've told her, "Well let's see your flight arrives at 6 PM ... and as we've established I wholly disagree with this letting her go home and I'm not going to be party to it, so you all have a nice day". I could've gone on with my day and not been a party to any of it.

That would've left SIL with a need to ............A) she can rent a car, at the airport .. and retrieve her luggage and set out for the hospital .. at that point, which is .. from that direction at least an hour .. to get to ...and her mom having been officially discharged and/or . limbo .. or whatever .. or she can B) get a taxi to her mother's house ..and there get the mother's car and go get her mother .. either way an add'l hour to go get her mother who has likely sat in limbo at this point .. waiting for some d*mn body to go pick her up.

Washing my hands of all of it .. and going in my own direction yesterday would've looked a little like the above and/or MIL be left to her own devices to call a taxi .. (or DH could've taken off work .. to go do it .. but he is pushed, and stressed out at work, being not enough of him and too many places to go and be), .. I could've just said, "well she can call a taxi, do you people hear me, I won't be a part of this".

MIL was given instructions .. and rx's .. and those rx's were retrieved on the way home (by me facilitating same).

Had I washed my hands of it, and MIL having to take a taxi to leave the place, which I guess people have to do .. and she could do .. if she's as able bodied as she wants us all to believe (she is NOT) .. then she can have the taxi also sit at the Walgreens drive-thru .. meter ticking .. for her to retrieve her rx's. And/or SIL can hop in the car and go get them once she gets her mother .. having gone the gamut above ..

That's why it kinda went the way it did yesterday.
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Dorker,
You are right, rehab won't fix her broken brain. But! Rehab might improve her quality of life, if she would cooperate. AND, the poor soul that becomes her caregiver, it might make their life easier if MIL could regain any amount of strength or mobility.
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lizzywho: MIL's broken brain. She says things that contradict one another. Mostly she argues that she needs any of the above. But every once in a while there is a glimmer that she realizes when she says things like: "I realize things have changed and I'm going to have to change with them and do all that I can to help myself".

That gets said .. infrequently .. but it does get said.

What is said more frequently is this: "I just don't want all this, this is not what I'm about .. I don't want all these trips to doctors and rehab and physical therapy and all these pills and all of them with their clutches in me, I want to be left alone", followed by: "I just want to wake up on that cloud in the sky".

Yes the discussions go on as you'd imagine: "Well that's great, that's a good thing that you want to do all you can, it's going to be really important you do so".

(but then in the end, it doesn't get followed thru, see med non complaint, see dietary issues that cause dehydration and lack of nourishment, etc etc, see missed doctor visits, etc etc).

Or the dialogue that goes on as to the other thing that gets said far more frequently: "I know that this just is not what you want, I get all that .. it has to be very much a PITA that you have to do all this and you just want to be left alone to do as you please .. I can only imagine how hard it all must be .. but ya know .. as long as you live .. there will be things that go wrong .. and so what you have to do is address it as it comes .. if you had strep throat . the doctor would give you antibiotics .. you wouldn't NOT take them .. you'd obviously want to get well .. these are the measures that you need to follow to get better".

Followed by her typical response: "I just want to wake up on that cloud in the sky, I don't want all this . .. ya know .. in every direction there is a *fix* for this and a *fix* for that, we'll throw this pill at this problem, and that pill at that problem .. and then you can go here for PT or we an send them to you, or go there for this specialist and that specialist .. and I just don't want all this".

So you follow that with the logical dialogue of, "Well you know that sounds a little to me like what you want is to go to a nursing home and just sit in a stupor and not be a participant in your own life, is that what you want?".

That gets responded to as follows: "No, don't you guys stick me in one of those places, don't you dare".

Well MIL .. if you want to remain an active participant in your own life and your well being, you have to do the things you need to do to get you better.

And it goes back to, "I just want to wake up on the cloud in the sky .. I don't want all this, this is not what I"m about".

Round and round and round it goes.

Brain ...????...... not comprehending/processing ..????....I'd say so yes.
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I started typing something rather harsh concerning the space between now and the time she floats up to her place on the cloud. But, it's all been discussed before among us in a more polite manner.
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Dorker,
When I said harsh I did not mean directed towards you. Just harsh as in what MILs life/quality of life in reality will probably be vs what she thinks the wait for the cloud will be like if she chooses not to try to help herself.

This is kinda rambling not sure if makes sense to you. Rushing out of here.
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Dorker - Pardon my long post. The minute that MIL said that she was refusing any treatment and would not go to rehab, any chance that she would be admitted rather than held for observation by hospital went out the window. Medicare has some pretty harsh rules for hospitals that have patients that are revolving door - get admitted/treated/then back for treatment after non-compliance or bad care. So the hospitals now have an observation status if you show up and present with symptoms that patient is not going to allow be treated in-patient or that really won't be treated well as out-patient. You don't have to agree to treatment - but hospital is not going to admit you if Medicare isn't going to pay or will fine them later when you are right back in. The hospital is required to inform patients of this so that they are NOT surprised when the bill from Medicare is not paid in full. Medical staff want to treat patients and make them as well as possible - a patient who tells you in advance that they won't take their medications, won't get a proper assessment of medical condition, and won't do any prescribed rehab is going to be stabilized and sent home. PERIOD. That is all the hospital staff is required to do with a non-compliant patient - stabilize them and discharge with recommendations. Your MIL won't take her Lasix consistently or as prescribed. She won't use assistive devices consistently. I've known doctors that fired patients for less. The medical diagnosis is SDS - Sudden Death Syndrome. The patient has so many co-morbidities and health issues that are not being managed BY THE PATIENT that doctors anticipate death from any number of things any day now.
I will be direct with you because I HAVE BEEN THERE. You have been sucked right back in. Taking MIL from hospital because "no one else can". Picking up SIL from airport because "no one else can". Sitting at hospital in the room listening to rant rather than leaving the room or waiting downstairs until MIL is released. Offering to attend care meeting to "present the truth". You just undid all your hard work by proving that you WILL get involved. I'm sorry that you have put yourself back in the thick of things. Hopefully you can get back out, but we all fall back. I did until I'd finally decided that I valued myself and my life more than my in-laws or my husband's dysfunction. Take care of yourself so that you can be a grandmother. Otherwise your thread will go on for years about the MIL's latest health crisis and H and SIL lack of involvement. Peace out.
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Dorker, did MIL sign the discharge papers at the hospital? (I hope you didn't do so; that would make you responsible for her after-care.)

I see what you mean about needing to be there for the in-home assessments, because the truth of her deficiencies might not be revealed otherwise.

I can't imagine how this is all going to end. I don't think SIL or H will ever overcome MIL's refusal to be placed in a facility. And apparently MIL will not agree to in-home help, either. She is still considered competent, correct? Then WHAT is to be done?

Do you think SIL will be able to spirit MIL away to live with her? She seems to be unable to stand up to her mother, so I can't imagine how that would ever happen. (I also feel for BIL, as awful as MIL treats him; what are HIS thoughts about MIL living in their house?)
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Dorker - go to the 10am meeting to give input - then back off, completely. No one is going to see the crazy unless they are ALONE in it. No one is listening to you - so stop trying. There will be a medical emergency and the decision will be made for MIL, SIL, and DH. (by the way - this happens all the time - it did with my dad, for example).

Breathe deep.....
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We ran into this scenario with my mom and it was a lousy way to learn these little rules. She'd blacked out, was aphasic when they found her. They ran tests at the hospital, couldn't find a cause (later decided it was a TIA) and two days later, I got a call that she was being discharged. We got into a heated argument with the discharge planner about her being an unsafe discharge. But as she was admitted "under observation" as opposed to inpatient and had no diagnosis, we had no rights or way to fight it. Medicare is clamping down and hospitals are erring on the side of caution. Also, Medicare can come in later, review the case and reclassify the patient as observation after they were previously inpatient. AARP did a good article on this. We were told that if we insisted she stay, she would be responsible for the medical costs, as Medicare wouldn't cover them.

Two days later, she blacked out again, hit her head and was transported by ambulance from her AL. This time, we battled it from the get go. We were fortunate that she had the same doctor at the hospital, who really worked with us to get her the tests and care she needed. She was dx'd with failure to thrive, with the OT and PT evals, she was able to just be over the needed three day stay. She was transferred to rehab and we immediately requested that the rehab look for a long term bed for her.

Lesson learned - now one of the first things I check on with my FIL at the hospital is his admission classification.
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My hubby always says to me "Doing the same thing over and over and expecting a different result is the definition of mental illness". Now, he says that to ME, b/c I have a very difficult mother with whom I am constantly at odds. He sits quietly and lets me rant the says his bit and he's OUT. No more discussion. Mother has been this way for my whole life.....and so I am passing this bit of info along to you, Dorker. As long as you are IN ANY WAY involved in MIL's life, you are keeping this circus running. I know why you do---we're fixers, helpers, etc., and it's in our NATURE. But, can you just literally and physically step away? Your SIL has a ton of nervous energy, it's HER mother, your hubby sounds ground to the bone....and I'm sorry, but often times our "loved" elders just DON'T get to make their own decisions. Like a toddler who needs a nap. If EVER a person needed to be in some kind of long term care, it's your MIL. And it's too bad she doesn't want to go. Tough. She's ruining so many lives....and you're all letting her. (said with compassion and GREAT understanding).

I'd love to see a post from you that says you had a great week and did your church work and spent quality time with your hubby and not hear about MIL's latest drama. I realize these boards are for venting....and I appreciate that....but you sound so angry and so desperate..and the answers are right there in front of you. At this rate, you or hubby are going to stroke out and then what?

It's very hard to disengage. I'm sympathetic to that--but you need to or this will just go on and on and on......
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Oh Dorker, I understand why you picked up MIL, you're still your husbands wife. You've been & will continue to be a team. Picking up SIL, I wouldn't have done that one. The 10am meeting? Yes you needed to be there as the person who is no longer going to cover for MIL. I can only imagine the picture the therapist would've gotten without you there. Going to the meeting was still within the scope of stepping back & getting her outside help. We learn from each other here & I really appreciate the heads up on the inpatient/outpatient classification & how important that will be. I'm so sorry the hospital through that monkey wrench into that circus! Maybe SIL & H would've followed through if rehab was an option but now we'll never know. Well, until the next crisis. Good wishes to all of you. You're doing great given the situation.
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Hospital stays for elderly parents requires such attention to details and lots of questions by family. When my mom was in the ER for the second blackout, the ER doc was a bit flip and superficial in his questions etc. I was getting irritated because obviously with two admits in four days, something was going on. Then he said that people fall out of bed and it's not usually serious. ??? It turns out that the EMTS were told she'd fallen out of bed. In fact, she'd been walking near the bed, blacked out and hit her head on the nightstand. His whole demeanor changed and he started to order more tests and different approach. A side bummer was that falling out of bed never got changed in the hospital computer, causing Medicare to refuse paying for the ambulance since she could've been transported by car, in their opinion.
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It's a balance I'm still trying to find. My intention was always to step off the wild merry-go-round of it all, and still is. I never said that I was going to turn my back completely from all of this (though sometimes I wish that was an option). I would hope that if it were my mom (I know darn well that DH wouldn't be in it knee deep as I have been for forever), but I would hope that if I needed him with regard to my mom . he'd do what he can to facilitate that. I know he wouldn't do as I've done for years and years. Not only does he not have the time, but he also wouldn't be in this kinda mania for years and years .. he'd of halted it. But ... I guess .. it's a horse of a different color when it's your own mom.

I don't want to be in the middle of the stupid rabbit holes and all the wild goose chases and stuff that makes no sense to me whatsoever. Done with that, and will continue to draw back from all that.

A perfect example today (didn't say it in front of MIL but did say it to SIL later) . the home health nurse there .. and they were talking, just in passing .. of assistive devices and so forth as to making your home more accommodating when you have deficits. She mentioned lift chairs (recliners that go to a full standing position and vice versa) as MIL struggles to get up and down. SIL wanted to know more on this topic .. it was being discussed, and prices and so forth. SIL asking .. wonder where we could go look at those .. and so on. I didn't say much at the moment. But I did later tell her, "I wouldn't get too entrenched in the lift chair thing .. we don't even know at this point .. we know she is going to where you live for sure .. and if that fails .. she can't live alone, she won't be needing a lift chair here".

A rabbit hole that could've begun to open up. But I shut it down. Let it be known, I won't be on the hunt for the "perfect" lift chair.

Today's "assessment" turned out to be really nothing more than a home health nurse, having come by to take vitals .. talk concerns, list meds, that was about it.

She said her job is to write down concerns that they may be able to address, and YOU KNOW I climbed on that bus .. talked about lack of compliance with meds, .. lack of ability to hydrate and take care of her own nutrition .. transportation problems going forward (prohibited from driving). She said her job is to try to educate on meds and what they do and why, etc.

Talked at length about Lasix and the pitfalls of not following through (been there/done that), but I'd gone there purposely to provide input into all this.

It wasn't quite what I thought it would be .. this sit down assessment.

Some of what I mentioned as concerns .. the home health nurse person said that we might benefit better from calling the area agency on aging .. and they may have some ideas (Nutrition, etc) ... SIL said that she has her mother on the list for MOW . and that when she was here in May .. she'd sat down with one of their social workers who was going to filter her through the system to see what services she qualifies for and would get back to us. I asked SIL to follow up with them .. it was May when she last talked to them, this is July.

MIL was using her walker, . (she only appeared from in the back as we began talking, her using walker as she came into the room). There was talk of that necessity and MIL didn't balk. She didn't come right out and say no, she wasn't going to do that, as she has done so vehemently in the past .. but she also didn't argue the point.

There was talk of what will transpire as to PT and OT .. and she listened/participated in that conversation ... talked of dread of having to do all that .. but didn't balk and argue that she isn't doing it.

I asked the home health nurse to explain to her the pitfalls of failing to take her meds daily .. at the same time ... as best she possibly can .. as in blood thinners for A-Fib and clots and so forth .. and she did so.

All in all, it wasn't what I thought it would be . this sit down session. But I guess, my participation there, at least it made me feel better in that there is a clearer picture on record, at least to lack of med compliance .. because I provided it. FWIW.
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So none of MIL's kids recognized the need to speak with any of the physicians that treated her while in the hospital? Not even SIL? What was her discharge diagnosis by the way? And where WAS her PCP in all this?

I am surprised that no discharge planner did not seek out an immediate family member to review her discharge plans and needs at home but I guess many things have changed in a hospital setting over the 4 years since my mom was in them. I am surprised SIL & H did not speak to any of her physicians either if this is indeed true.  So the MIL in essence directed her care in the hospital as well. I would hope the discharge planner would seek out her family to make sure MIL wasn't going home to an unsafe environment confirmed by a family member. Was she taken to a hospital where her PCP didn't have privileges?

So now SIL will wait on her mother hand and foot therefore not witnessing her mother's true level of function.

I agree with you Dorker. I could not have said no to picking MIL up from the hospital. Same with the SIL.

Why are her children so afraid to tell her their mother how ridiculous she is acting? Your husband began to while she was hospitalized but was called mean. She must have dementia if she keeps saying she knows what to do to take care of herself but can't even take her daily medications. SIL took her to DMV on her last trip to see her mother before this? SIL is in denial big time.

I hope you can back out again Dorker. It does seem like your H and SIL do not really communicate with each other either about LTC for their mom.  Are they afraid of her? Was she mean to them growing up?

MIL will be allowed to stay at her home alone when she refuses to go stay with her daughter now. You watch, the SIL will make some excuse like she doesn't want to take her mother far from her doctors. Your MIL will refuse, and then it's back in your lap. 

Then all will be back to square one. You. Your husband had a taste of it, he's too busy, he will guilt you into doing it, and there you have it.

Status quo until the next health crisis. 

Those lift chairs cost a lot and many people love them. But she needs to use her arms to lift herself out of the chair to get some exercise to her upper extremities. 
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Shane, in all the hospitalizations of my MIL, I never saw her PCP, but a hospital assigned doctor instead. A hospitalist, I think they're called, who oversaw her care there. The discharge planner was probably told by Dorker's MIL that her daughter was going to be there to care for her upon discharge. What may help Dorker's husband in future hospital trips (and thus help Dorker) would be for him to have a full list of all of her meds, including meds that she should not take, such as the Lipitor.  And he needs to be there for the discharge instructions.  But with MIL being under observation, the family really didn't have a real options, such as rehab.
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Dorker, i think you did exactly what I would have done. I'm glad mil is using the walker! That's a real change in her compliance...maybe there is more to come.

MiL clearly thinks that folks in " facilities" are in wheelchairs in a stupid. Not sure where that comes from.
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What Linda22 said, hospitalists. Yes. Her PCP never came to the hospital, and specialists are also associated with the hospital there. Even though she has a cardio doc and a neuro doc .. the hospital specialists are the ones who attend to the issues there, and then all this info gets referred out to the physicians she sees normally, for follow up appointments.

DH was there when the neuro doc had come in and questioned her being able to go home and that's when the neuro doc indicated he didn't agree with that, but that her daughter is coming and so that should suffice, as long as daughter is agreeable to her care.

There is a list on MIL's fridge of all her meds .. and DH has been told this, though it's been quite some time .. we don't review that weekly "Remember if you should have a problem with your mother's health .. grab that list of her meds off the fridge and take it with you". He probably long ago forgot that was there, but has been reminded at this point. Likely if it happens again, he'll forget .. again.

Yes MIL presented today .. with walker. Interestingly enough also, .. as the home health nurse began to talk of what PT will do, what OT will do .. after their assessments are complete (have not visited yet), MIL was right there .. she heard what was being said. She didn't argue. She didn't agree and participate in what was being said, but she didn't argue. Interesting.

I did ask DH again, .. as we talked of all this ongoing and also on his mom having gotten really pretty upset with him. His stance is one of .. she didn't want to hear it, the facts .. that things are going to be changing .. so she got mad .. she can get over it, things are going to change, that's all there is to it. (I hope he means it, .. I guess we'll see). He went on to say, "last I heard the plan going forward is that SIL wil stabilize MIL well enough to make the trip to where she lives, to go stay with her .. ". I asked again, "You guys have this wild assumption she is going to go . .with her daughter .. what if she flat out refuses, what's your plan B". He said, "SHE IS GOING ... she has no choice, .. SHE IS GOING". I said to him, "I don't see your sister taking a weeping mom . all that way .. and dealing with that, and her crying that she doesn't want to be there, to take her home". He said, "She is going! She can't live alone, she is going".

We shall see. I can only hope he stands firm in that. But I stand firm in, she is not coming here to live.
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Oh and FWIW .. I left there about noon and went to retrieve my 4 yo grandaughter and we went to an indoor play gym and to lunch. Brought her here with me, . .she and I put a roast together for dinner, that we'll carry over to the dd's house .. and enjoy the babies and pot roast.

Nice to be away from the geriatric scene! So nice!
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I don't know what I would have done, but I do see things happening.

dH is taking a very firm stand with his mother and his sister. He is declaring that mil cannot stay home alone, and the only option is sil's place.

Mil, having, in hospital, gotten her independence and self governance needs off her chest once again, to no avail, has acquiesced a little. It is the thin end of the wedge. I don't think she is going to suddenly turn into a compliant person, but I do think that some of her brain cells are realising that changes have to be made.

Just keep the pressure up, in a firm but caring manner. Surely sil and mil must be learning that this time around, mil cannot be set up to function in her own anymore. Or, there will be another crisis, which will move things in the desired direction. Unfortunately, sometimes it takes that. I hope it doesn't.

Glad you enjoyed your granddaughter and are standing firm about the yellow room.
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Want to take the pulse of those who have been cheering me on, and helping me through all of this.

It was my choice today to go over and be a part of what turned out to be just a mere home health nurse visit, .. wasn't really what I had hoped it would be. My hope was that it was an assessment of sorts as to where there are shortfalls in the whole setting, be that MIL's lack of cooperation (walker, meds, nutrition, hydration, doc visits, etc etc) and making that picture clearer. Point being, SIL .. I don't even truly think SIL has an accurate portrayal of how diminished her mother's capabilities are. How could she? She comes here and steps and fetches for everything as menial as a glass of water, to feeding the dog, to letting the dog in and out .. getting the mail, you name it. All .. things MIL has to do on her own, . when SIL isn't here to do it for her. MIL has to do all that, and more on her own .. as well as keep up with her meds (she doesn't), and see to getting to doc appts (she doesn't, not consistently), keep herself hydrated and nourished .. pay her own bills (MIL does that, not SIL), etc. She doesn't .. there are gaping cracks in all of it ..

It all runs fine as long as the caretaker Neurotic Nancy is right there on the scene .. but when she leaves, it falls through the gaping wipe cracks. Some of it, maybe even a large part of it .. I think is that MIL simply can't. Her mobility an impediment, ... and I truly think any level of function as to processing, "Well gee now I have a doctor appt at 9:30 .. I guess as slow as I am . .maybe I should really get a move on about 6:30 or so in the morning, because it'll take that long for me, .. with it all .. to get ready", that whole process, . lost on her. Unable to manage time any more. Unable to manage "processes/sequences", IMO anyway. I don't think it's always because she "won't" .. I think it's because she "can't". The walker, that's another matter .. she COULD and SHOULD use it .. and that, I think is vanity and pure out and out defiance. But we may have been able to cross that bridge (crossing fingers) with this latest debacle.

Yes, that still leaves us at square one. Whether she can't, or won't .. is immaterial .. if she can't perform the above and keep herself safe . she doesn't need to live alone. PERIOD. I've got that. But her two offspring .. (sounds like DH may be getting there, but may also be just shutting me up long enough to go about biz as usual, or hope he can) . and SIL .. I think complete utter denial of the real situation at hand. Oh sure, yes, she gives lip service to taking her mom back to where she lives .. but .. wouldn't surprise me, seen it ..lived it .. heard it all before .. if she doesn't somehow think it's all going so swimmingly well, that she thinks it okay to leave her mom here alone . in the end .. (who knows when, now that there are programs MIL will have to be participatory in), SIL in denial .. MIL crying crocodile tears that she doesn't want to have to leave her home, that she will be fine, she will manage. SIL will waltz off .. back home .. and here we are again. Wouldn't surprise me.

Yes, DH has paid lip service that things are going to change .. and he will be making some judgement calls on behalf of the situation and that .. his words .. "she is not staying here to live alone anymore". His words. BUT will he stand by those when the crocodile tears start and the SIL chiming in with the whole "well she just is so stubborn, she won't go ..", and on and on it goes.

Same story .. different day.

So what I wanted to get a gauge on is this. There are to be also, a PT eval assessment as well as an OT. I went today, in the hopes it would be a setting where some of the "real" concerns (that SIL doesn't see ... because she's too busy doing for her mom, every step of her life), that's what my intention was. It didn't really turn out to be that kinda set up.

Would you go to the PT .. and the OT assessments? Or just scrap it all, and say "g'luck to you guys, peace out", and walk away .. and be done with it, .. all to watch it all begin to fall into place again, that MIL gets to stay home and the thing fall off the cliff yet again.
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Also of note. Just some real interesting factoids as far as I'm concerned, from today.

One of those being that SIL had yes, the last time she was here, in May, taken MIL to get her driver license renewed. That had been talked about prior to the actual step of doing so and I had cautioned, "have any of us ridden with her as driver?, I sure haven't, don't ya think maybe we should do that, before we go waltzing in and have the license renewed, we don't even know how her driving abilities are".

As with most things, that got ignored, and the DL renewed. Her driving privileges now restricted due to the latest events .. events that essentially triggered this whole debacle, her out and about driving, and forgetting how to start the car.

Also of note .. I had mentioned here in this thread .. at one point .. about an elderly lady that attends our church, and that she had asked if MIL has OT working with her and I said to this elderly lady that no, we haven't done that. She went on to describe to me the things OT did that helped her . and advised that we should see about tying into that.

I did pass that along to SIL .. at one point .. and thought that would be a really grand idea. Went nowhere.

But yet here we are .. OT going to be called into the care team. Hmm .... maybe I really do kinda have a clear understanding of the whole picture here (which I've said all along, I think it's SIL that maybe DOES NOT).

Also interesting .. I was asking the nurse, truly I was curious about this. When MIL arrived at the hospital the other night, her BP was pretty high. Not typical for her, .. her's usually runs low if anything. She was also very bloated .. legs/ankles. The hospital gave her something, .. Lasix I guess .. to rid her of fluid. Her BP ultimately returned to it's normal low readings. My question was: "So . her BP was abnormally high, but she was also bloated with edema in her lower legs .. and once that was removed from her system .. her BP returned to it's normal, .. does not taking that Lasix . .and the result of that, the fluid build up, does that also bring with it, higher BP?".

Nurse answered in the affirmative .. that her heart is having to work harder to rid the body of fluids .. and it's unable to do so .. raising the BP. (Laymen explanation).

So then fast forward a few conversations later, when it was being asked by SIL .. "so these microbleeds .. what is that, how does that happen?, how'd she get that?".

Nurse answering: Lot of risk factors there,

prior strokes
high BP

Nurse was going to continue down the list of risk factors, but got interrupted.

SIL interrupts nurse at this point, "she has low BP .. she hasn't ever had high BP".

I then interject, .. Uhm ... we probably just didn't know that her BP was spiking at times because she fails to take her Lasix as she should and she routinely gets fluid build up as a result.

Nurse then went on to explain that failing to do so, .. worsens the CHF .. as the heart continues to have to work harder .. it's a cycle, .. the heart now unable to do what it needs to do to rid the body of fluid and the CHF worsening.

So there! Again, another point I've hammered home time and time and time again, LIKELY BECAUSE I HEARD IT SOMEWHERE ALONG THE WAY IN ONE OF THE MILLIONS OF DOC VISITS ...

But she will manage, she knows what she needs to do and she'll do it.
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Home PT & OT should help her & no I don't think you have to go. PT will give her exercises for strengthening and have her complete them while there. OT will assess how able she is to bathe and dress (ADL's) and  offer suggestions on home safety and encourage the family to install grab bars say, in the bathroom, etc.  
Most likely they will come 2x/week and the nurse probably twice a week then decrease to once per week as she improves. PT will teach her how to go downstairs safely is she has stairs to go down to exit her home safely.'
RN should teach her medication purposes and assess her neuro status, weigh her daily, listen her lungs. etc. Visits last about 45 minutes , less for RN's.
Home care usually stays for 4:-8 weeks; the nurses for 4-6 weeks. One HC episode is 60 days. If needed to extend, they can re-certify for another 60 days.
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PT and OT should be able to assess independently of sil's input, I think. though sil may try to minimize some things. I find it hard to put myself in your situation as I am POA for my mother. Even then, generally speaking, I stayed as much out of it as I could, trusting that the professionals could do their job. But, then there was no one else in the family giving input.

Maybe someone more familiar with PT and OT assessment would know how much they rely on family input re ADL's.

I think your concern is that sil will give false information about mil's capabilities and thus the assessment will indicate a higher level of function than is reality. If family input is a important part of this process, I think I would go so that the assessment is accurate.

Maybe you can find out how important family input is for the assessment. I hear you that you don't want the "mil can manage and knows what to do" scenario again.
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Dorker, write a list of all of the things that you have observed SIL do for MIL in the last 36 hours alone. Hand it to her. Ask "what do you think happens when you're not here?" Make sure the list is also handed to the assessors.

By the way. If MIL becomes consistently unreliable about taking her diuretic, her anticoagulant and any BP meds she's supposed to take, before long the issue will resolve itself because she will stroke. Then she'll be in no position to argue about anything much. If you were a much crueller person than you are you could ask her if that's what she's working so hard to achieve.
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The OT and PT assessments are going to involve more "show" than "tell." (This is from experience with my mother's PT and OT assessments.) For instance, the OT could say, "Show me how you do your laundry. How do you carry the laundry to the washing machine?" And so on.

While the PT and OT do the assessments (beginning and end of program), it's actually a PTA (PT Assistant) and OT Assistant who come to work with the patient. They are trained and under the supervision of the PT and OT.

MIL will be expected to do therapy exercises daily. While SIL is there, they might be done. Once SIL leaves (assuming MIL refuses to go with her), that will probably be the end of them.

I don't remember; is MIL's bathroom outfitted for her mobility and balance problems? If not, the OT will have lots of input there. Examples include grab bars in and near the tub, non-skid mats, raised toilet seat. The OT will also go through the house and look for tripping hazards.

I think Countrymouse's idea of the list of all the things that SIL is doing for MIL is excellent.

Your MIL is similar in some ways to my mother. But my mother is exacting in following her medication regimen (I think she takes too many, but that's another story). She did do the therapy exercises outside of the therapy sessions. Like your MIL, though, she refuses to accept her limitations. Which is why we are also waiting for the crisis that lands her in the hospital and then possibly a facility. I will not do what your SIL does for your MIL.

Keep us updated!
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Countrymouse, thank you. Absolutely. I will ask, not MIL that question, but SIL. Indeed. She doesn't take her meds, .. consistently. I think the blood thinner (Elliquis) it gets taken 2x's daily. And that morning dose ... oh ... she may get to it about noon, or sometimes earlier because she does see it through, sometimes not  ... oh yes, it's there in her pill vial, .. a pill vial that SIL watches her, when she's here of course, dutifully fill and she micro-manages. But what of, when SIL is not here. I haven't been going over to manage that aspect, nor has DH. She can manage, remember.

And as we know, the Lasix, that can go days and days without being taken (mobility the impediment).

When put in those terms, so concise, it does make it pretty evident where this is all heading. She can manage, she knows what to do. Leave her there to her own devices and the above is what is routine. Not taking the Lasix, fluid building, heart working harder to rid the fluid .. and no blood thinner consistently on board, a clot and that A-fib fires up and the heart jumps out of rhythm, there ya go, massive/debilitating/catastrophic stroke.

Was very telling yesterday as we sat with the nurse and went over meds. The topic of the Lasix came up and the fact that she takes it only when she's just about into cellulitis with the swelling (and it has gone to cellulitis before). Nurse asking MIL why is that. MIL then explaining that when she takes it, she just finds that she has to get up and down all the time, and go back and forth to the bathroom and saying the words, "I just can't do that, I'm not able, and I can't seem to make it to the bathroom in time because I can hardly get around, and so I"m peeing on myself, I just am not able to do it"   

Discussion of  *perhaps, when you take it, you just have to wear Depends*.    I get it, the indignitity of it all, .. I do get it.  BUT ... it is what it is.   NOT TAKING IT ISN'T AN OPTION .. UNLESS .. you are going to do the support hose, see below.    

UGH .. if you had ANY IDEA how many times this same dialogue has gone on, and yesterday .. it's like it has never happened before ... I've heard all this so many times .. I could recite it all myself.

The nurse then asking if she has ck'd with her doctor on what she has been doing, .. just holding off on it, and not taking it. And MIL answering that with, .. a confused/delayed .. "well no not really", .. and SIL jumping into the conversation with, "they told her, she's on 20 mg, they told her if she wants, she can just cut them in half ... but you know that's near impossible with those tiny little pills .. she has these arthritic hands .. it's' just too hard for her to do that" (making excuses, for someone who is so vehement that she knows what she needs to do and will do it, she'll manage).

The nurse then explaining to them the pitfalls of not taking it .. and what the results will be (heard it all before). And then explaining (heard this so many times before) that if she can't take the Lasix .. she really should be wearing support hose.

I've preached this (having heard it and heard it and heard it) .. MIL then showing her arthritic hands that don't close, she can't "grip" .. and so it would be a struggle for her to get them on and off. And the nurse then explaining that there are assistive devices to help get those on and off, and there are even some neoprene with velcro that can be specially fitted for her. Now SIL off on that tangent (as if MIL is going to do it, rabbit hole/wild goose chase), SIL: "Really? I didn't know that, tell me about that, .. that may be something we need to get". The nurse now explaining the neoprene hose things .. and that they are fastened via velcro, after being specially fitted for her alone .. and so SIL now on that train .. and where do we get something like that .. and that's explained to her as to location for same, and now SIL hopping on that, .. that they'll have to add that to the list and make sure she can get some of those.

Yea you go .. you do that. And they will sit in a drawer unused. I didn't say that, I sat there silently. Been there/done that, so many times.

SIL minimizing.   Me,  the realization (the grasp on the reality) that MIL will not use that. She won't. This ground has been covered so many times.

That, I suppose .. (though it really is maddening, to go over the same things over and over and over) was one good reason that i was there, on site, just the minimizing that SIL does.
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I wonder if you could draw her some pictures.

Simple colour-coded diagrams, to show her what happens to her heart, lungs, kidneys and brain when she doesn't take her diuretic.

Or you could use red food colouring and water.

Remind her that the red represents how much oxygen is in her blood stream. That every organ in her body needs oxygen to work.

Dilute the coloured water gradually, and explain this is what happens to her blood when she doesn't take her diuretic.

Her kidneys need oxygen to function. If there isn't enough oxygen, they get worse, then more fluid builds up, her blood gets more dilute, her kidneys get less oxygen...

Same with her heart. We tend to forget that the heart is just a muscle, and that if it doesn't get enough oxygen it doesn't work so well, so it doesn't circulate the blood, so it gets less oxygen...

And the lungs, and the brain. Especially the brain. Too tired to get up and go to the bathroom? But if you don't take your diuretic, your brain will have less oxygen and you'll feel tireder still.

Diuretics need to be taken at a regular time of day. Do that, and then you know exactly when you're going to need the bathroom most and you can schedule your day around it. It's much less of a problem if you can predict accurately what is going to happen.

Seriously: simple diagrams. She needs to see what she's doing to her poor old body when she mucks about with her medication. And don't forget to throw in that wonderful old saying "prevention is better than cure."
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I met with the p.t. and Alzheimer's nurse the first time they came to my Mom's. You can go to those, get everything out that you want to say, and observe how it goes. Next go get beautiful 4 year old granddaughter, put a life jacket on her, and you two go jump in your backyard pool! You have to relax a second while SIL is there. This is your chance !
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Oh I have my answers this morning as to what I will be doing with my time.

My poor dd, while I've been in the road managing this til SIL could get here, .. she hasn't been sleeping. She is sleeping, around the clock, dd, in hour or so increments, as the twins tag-team on being awake.

Went there last night to take dinner and she happened to have a friend over visiting (long time friend of her's that I know and think of as a daughter, sweet girl). The girl asked dd, "so how are you doing?". DD .. (who looks so so tired, eyes are so sleepy looking) dd answered, "....well .. fighting the baby blues, in tears a lot .. but just exhausted". The friend (has no children) "how does that go?, what's that about". Dd explaining to her the exhaustion of babies that won't sync with their sleep schedules and being unable to adequately rest, hormones trying to resume normalcy .. baby blues, etc. Her friend asking her, "oh man, what can you do?". Dd responding, "it's just the way it is .. nothing you can do but just get through it".

I could've cried. Isn't that what I said in the beginning of all this, that I WILL NOT BE AVAILABLE TO THIS SCENE WITH MIL and her needs, I will be spoken for on the front with my dd. That's what I said all along as this pregnancy progressed with complications and the upcoming twins. And then it got temporarily derailed .. with my being on the MIL front. I had backed away from dd ... at one point and let them have their autonomy to manage it, and soon found out (dd not one to complain and ask for help) that she wasn't indeed managing as well as I might've thought. So I jumped in again, headlong .. and she, so grateful, as I'd come and rescue .. be that take care of babies so she can sleep, be that take the 4 yo out and get her out of dd's hair . be that help with house-cleaning, meals, etc. So grateful. Then, .. MIL's situation fell off the cliff (as it always does) and I went in that direction.

I hear from dd this morning that she slept a total of 1 hour last night.

I know that dd did call on her younger sister the other day, having had 1.5 hours of sleep the night before .. her youngest sister did go and help her for a few hours. Dd aware at that point that I was on the MIL scene, didn't ask for my help, asked for youngest sister's help.

Dd reporting in to me this morning, via text, that last night was awful .. that the little boy baby didn't sleep at all. She got 1 hour of sleep.

I am going in that direction. I had already planned to pick up the 4 yo and take her to the library story hour, and I will do that, but then will return to their home with the 4 yo and send dd to bed and I'll deal with the babies.

As much as I think it's important that my input be a part of the scene over with MIL .. I think it's more important that my dd have some adequate rest.

I have my answers as to where my allegiance needs to be at this point.
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